Saving C-sections for those who really need them
Cesarean delivery (C-section) is the most common surgery performed in the U.S. today. One in three babies are delivered this way, yet there is no evidence of improved outcomes for many of the women who have C-sections — or for their babies.
For a select group, a cesarean is the safest route for mom-baby health. But most experts agree that we need to reduce cesarean delivery rates for low-risk women, and reserve this surgery for those who truly need it.
One of the most common reasons to have a C-section is the slow progression of labor. However, new scientific data show that normal labor progresses much more slowly than the rate that many doctors have been taught was normal in the past. This recognition has created a safe opportunity to prevent “overuse” of cesarean delivery by encouraging healthcare providers and moms-to-be alike to be more patient — particularly with the first baby.
In February 2014, the American Congress of Obstetrics and Gynecology (ACOG) and the Society for Maternal Fetal Medicine (SMFM) released a statement encouraging the safe prevention of C-sections by taking a more patient approach to managing labor. For example, slow but progressive labor before a woman’s cervix reaches six centimeters dilated should not be an indication for a cesarean delivery.
ACOG also advises waiting a bit longer once a woman’s cervix stops dilating in active labor to be sure enough time — up to four to six hours — has passed, before labor is considered to have stopped.
Finally, ACOG urges providers to wait until women having their first baby push at least three hours (two hours if they have had a vaginal delivery previously) before recommending a C-section, as long as mom and baby are doing well.
The emphasis on patience for the safe reduction of primary cesarean delivery rates is a simple yet effective way to increase the chances of having a healthy, normal delivery.
As an expectant mom, you need to be proactive. Ask questions about your provider’s practice when it comes to managing labor, and compare C-section rates at various hospitals if you have a number of options when choosing where to deliver.
Hope Ricciotti, MD, is Chair and Residency Program Director, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, where she is also an associate professor and a practicing ob/gyn.